Mastoiditis is an inflammation or infection of the mastoid bone, which is a portion of the temporal bone. The mastoid consists of air cells that drain the middle ear. Mastoiditis occurs equally in males and females. Mastoiditis most commonly affects children. Mastoiditis develops when middle ear inflammation spreads to the mastoid air cells, resulting in infection and destruction of the mastoid bone. Some symptoms and signs of mastoiditis to pain and tenderness in the mastoid region, as well as swelling. It may have ear pain (otalgia), and the ear or mastoid region can be red (erythematous).
Symptoms
Symptoms of mastoiditis may at first be the same as symptoms of an early middle ear infection. With progression, however, the swollen mastoid may push the outer ear slightly forward and away from the head. The area behind the ear will appear red and swollen, and will be very sore.
Fever or headache may also be present. Mastoiditis complications arise when the inflammation spreads throughout the antrum and in the posterior fossa of the skull, the middle cranial fossa, the facial nerve canal, and the sigmoid sinus side, and the end of the petrous bone temporal. Local Extension of the disease can cause serious morbidity and potentially fatal disease. If the infection continues to spread, the following complications may occur first is meningitis - an infection of the outside of the brain. second is brain abscess - a pocket of pus and infection that may develop in the brain. The primary treatment for mastoiditis is intravenous antibiotics.
Diagnosis
The diagnosis of mastoiditis is clinical—based on the medical history and physical examination. Imaging studies may provide additional information; the study of choice is the CT scan, which may show focal destruction of the bone or signs of an abscess (a pocket of infection). X-rays are not as useful. If there is drainage, it is often sent for culture, although this will often be negative if the patient has begun taking antibiotics.
Treatment
The mainstay of management of acute mastoiditis is placement of a pressure equalization tube or an incision in the eardrum to allow the infected material to drain out along with antibiotics directed against the particular bacteria present in the purulent material. If the mastoiditis has become coalescent, then a tube placed in the eardrum followed by a limited mastoidectomy to drain out the infection along with appropriate antibiotics will resolve the difficulty. For chronic mastoiditis attempts to clear it with oral or topical antibiotic therapy are first performed.
In the case of a very severe infection of the mastoid bone itself, with a collection of pus (abscess), an operation to remove the mastoid part of the temporal bone is often necessary (mastoidectomy).
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